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    <title>Document</title> 
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     <header>
         <span class="left"> < </span>
         <span class="title">填写签约信息</span> 
         <span class="left"></span>
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     <div class="box1">
          <p>签约信息</p>
     </div>
     <div class="box2">
         <ul>
             <li class="li"> <span class="zuo">签约机构</span> <input type="text" placeholder="洛西社区卫生服务站">   <span class="you"> > </span> </li>
             <li class="li"> <span class="zuo">签约团队</span> <input type="text" placeholder="李明明团队">   <span class="you"> > </span> </li>
             <li class="li"> <span class="zuo">签约医生</span> <input type="text" placeholder="李明明">   <span class="you"> > </span> </li>
             <li class="li"> <span class="zuo">服务包</span> <input type="text" placeholder="老人服务包">   <span class="you"> > </span> </li>
             <li class="li"> <span class="zuo">签约周期</span> <input type="text" placeholder="1年">   <span class="you"> > </span> </li>
             <li class="li"> <span class="zuo">生效日期</span> <input type="text" placeholder="2020年09月01日">   <span class="you"> > </span> </li>
             <li class="li"> <span class="zuo">费用</span> <input type="text" placeholder="￥120" class="inp">   <span class="you"> > </span> </li>
             <li class="box3"> <span class="zuo">备注</span>  
                <input type="text" placeholder="请填写备注" class="inpu">   
            </li>
         </ul>
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     <div class="box5">
         <div>提交</div> 
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